Healthcare Provider Details

I. General information

NPI: 1891068730
Provider Name (Legal Business Name): ANAND I DESAI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 BLACK RIVER BLVD.
ROME NY
13440
US

IV. Provider business mailing address

1819 BLACK RIVER BLVD.
ROME NY
13440
US

V. Phone/Fax

Practice location:
  • Phone: 315-336-7255
  • Fax: 315-339-2949
Mailing address:
  • Phone: 315-336-7255
  • Fax: 315-339-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number149307-1
License Number StateNY

VIII. Authorized Official

Name: ANAND I DESAI
Title or Position: CARDIOLOGIST
Credential: M.D.
Phone: 315-336-7255